Provider Demographics
NPI:1578567384
Name:CORDELL, LARRY DONALD (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:DONALD
Last Name:CORDELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:MS 3017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-6100
Mailing Address - Fax:913-588-8186
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MS 3017
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6100
Practice Address - Fax:913-588-8186
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-13939207X00000X, 207XS0117X
MOR7372207X00000X
CO38333207X00000X
CAC32504207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100093800EMedicaid
KS100093800FMedicaid
KS100093800CMedicaid
KS100093800DMedicaid
KS100093800BMedicaid
MO1578567384Medicaid
MOP00655492Medicare PIN
KS100093800EMedicaid
KS100093800FMedicaid
C50308Medicare UPIN
MO1578567384Medicaid
KS100093800DMedicaid